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Deep Brain Stimulation for Essential Tremor

Deep brain stimulation is a surgical intervention used to treat movement disorders such as essential tremor (ET) when the regimen of existing medications and the various rehabilitation strategies become less effective in managing symptoms.

For people with poorly controlled tremor, deep brain stimulation (DBS) surgery is often considered early in the disease. DBS is very effective in treating tremor.

The thalamus is targeted in the DBS procedure for the treatment of tremor disorders such as essential tremor. The DBS lead administers a controlled electrical current into this target, a malfunctioning portion of the brain. This provides an 80% reduction in tremor in 80-90% of patients.

Unfortunately, the stimulator does not cure or halt the disease and residual symptoms can increase with disease progression. DBS does continue to provide the same percentage of symptom reduction.

This video shows a patient who has essential tremor, and has had DBS surgery. The video shows him with his stimulator turned on and turned off.

When is it time to consider DBS surgery?

Patients should only consider surgery once they are experiencing significant symptoms despite best medication. Only the patient can decide what is a significant tremor. Patients with mild tremor may decide to have surgery if they have to work with their hands. Some patients may only decide to have surgery when their tremor is severe.

Who may be a candidate for DBS surgery?

People with essential tremor who have:

Not responded to or are no longer responding to medications to control their tremor such as beta-blockers or Primidone.

Disabling tremor that is interfering in their activities of daily living such as eating and drinking.

Who may not be a candidate for DBS surgery?

For people who meet one of the following criteria, DBS surgery is not a good option:

Are too unhealthy to undergo surgery

For people who meet one of one of the following criteria, DBS surgery may not be advisable, and should be considered carefully:

Cardiac pacemakers and defibrillators

By implanting the DBS generator more than 8 inches away from the cardiac device, most problems can be avoided. If the patient's life is dependent on uninterrupted cardiac device function, DBS is generally contraindicated.

Regular MRI imaging

Patients who have an implanted DBS system cannot have an MRI scan of any part of the body as it could lead to brain tissue damage.

Head MRIs can be performed using specific scanning equipment under the supervision of an experienced DBS team.

Anti-coagulant therapy such as Coumadin or Aggrenox

A specific evaluation is needed to determine whether or not these medications can be safely withheld for approximately three weeks.

What outcomes can be expected from DBS for people with essential tremor?

For people with essential tremor, approximately 80% of patients experience an 80% improvement in their tremor. The tremor will continue to progress at the same rate that it was progressing before surgery. The surgery continues to reduce the tremor by 80% many years after the surgery.

What are the potential risks of DBS surgery?

1-3% risk of intracranial hemorrhage which can lead to loss of speech, paralysis, coma, or death.

5% risk of infection which usually requires removal of the DBS system.

1-2% risk that DBS will offer little or no benefit. The chance of this is dependent on the patient's diagnosis or can be due to suboptimal lead placement, requiring revision.

Risks of anesthesia which are dependent on the patient's overall medical history.

What is the pre-operative DBS evaluation process?

Individuals interested in learning more about DBS surgery should contact the DBS team at (804) 364-6519 to set up an informational appointment. At this appointment patients are given a packet of educational materials. Clinical notes are obtained from the referring neurologist and primary care provider. If a patient has not seen a neurologist, an appointment with a movement disorders specialist will be scheduled to confirm that the patient is a good candidate for surgery.